Back Pain During Sleep: Causes, Symptoms, and Treatment

When you’re up at night tossing and turning because your back is killing you, it might feel like you’re the only person in the world who’s stuck in such an uncomfortable position. But in reality, you’re not alone. Countless sleepers are plagued by back pain and the costs that come with it.

Low back discomfort is the leading cause of disability worldwide. In fact, it’ll affect around 80% of adults at some point in their lives, says the American Chiropractic Association. And often the pain will flare up at night. That can make it hard to fall and stay asleep, which can create a whole added set of potential problems.

The good news is, it’s entirely possible to ease your back pain and even prevent it altogether—so you can feel more comfortable in bed and get the rest you need. Here’s a look at how back-related problems can develop, who’s most likely to experience them, and what to do to get better sleep.

What Causes Back Pain During Sleep?

Back problems, especially lower back problems, don’t always have an identifiable cause. Most often they come about from sprains or strains, like when you repeatedly lift something heavy or make an awkward movement, according to the National Institutes of Health. Ruptured spinal disks or sciatica, arthritis, osteoporosis, and skeletal irregularities like scoliosis can lead to back pain, too.

Back problems caused by sprains or strains often clear up after a few weeks, provided you give your body a little TLC. (More on how to do that later.) But pain caused by chronic health problems can be long-term. In both cases, your sleep situation can make the pain worse: Frequently, snoozing in a wonky position or using a mattress that’s too firm or too soft can make back pain worse.

The Pain-Sleep Cycle— And Its Costs

Anyone who’s ever dealt with nighttime back pain knows that it can stand in the way of getting a restful night’s sleep. Trying to get comfortable can make it tough to doze off, and it’s common to wake up hurting in the middle of the night. (Your sleep can also be disrupted even if you don’t remember waking up. Back problems can contribute to brief disruptions called microarousals that prevent you from reaching the deepest, most restful stages of sleep.)

And the problem doesn’t end when you get out of bed. It’s no secret that falling short on sleep can zap your energy and your mood. What you might not know? Sleep deprivation might actually make your back pain worse. Too few Zzzz’s can actually make people up to 30% more sensitive to pain, according to findings published in the Journal of Neuroscience. Over time, not sleeping enough could even change pathways in the brain that amplify pain and make it feel worse.

In short? Pain-related sleep disruptions can create a sort of vicious cycle. As your pain gets worse, it becomes even harder to sleep. And as you grow more and more sleep-deprived, you end up more and more uncomfortable. Over time that can add up to missed workdays and less energy for the activities you enjoy, and even a higher risk for depression.

Knowing Your Risk Factors

Back pain doesn’t discriminate, and it’ll affect most of us at some point or another. Still, some people are more prone to those aches and twinges than others. And if you’re one of them, it makes sense to be proactive about protecting your back both during the day and while you sleep.

So what groups are most likely to be struck by back problems? You may be more likely to be affected if you:

Are over 40. In general, older adults are at higher risk than younger ones.

Are overweight. Carrying extra weight puts more strain on your back.

Are pregnant. Pelvic changes and changes to the way you carry your weight can lead to back issues. (The good news is that pregnancy-related back problems usually clear up after giving birth.)

Have a sedentary lifestyle. Inactive folks tend to have weaker core and back muscles, which could contribute to discomfort.

Have other chronic diseases. Problems like arthritis and some cancers can play a role in back pain.

Don’t use proper form when lifting. Lifting heavy objects with your back instead of your legs can trigger painful injuries. That’s especially true if you have a job that requires you to lift heavy objects often.

Have certain mental health conditions. There’s a link between back pain and depression and anxiety.

Is Your Sleep Position Hurting Your Back?

Plenty of folks are plagued by backaches and can’t figure out where they’re coming from. If you’re one of them, it makes sense to look at whether your sleep might be contributing to the problem. Poor posture while you’re laying in bed can go a long way towards determining whether you end up with back issues, say Cleveland Clinic experts.

So how can you tell whether your sleeping position is contributing to the problem? If you wake up with serious morning stiffness or find that your acute or chronic back pain tends to flare up in the middle of the night, it’s safe to assume that the way you’re sleeping (or the mattress you’re using) is at least partly to blame.

The Best Ways to Treat Back Pain During Sleep

If your back problems seem to be most noticeable at night or first thing in the morning, start by making changes to your sleep environment. That alone is often enough to make a difference for plenty of people with mild to moderate back pain. Some nighttime steps you can take to treat and prevent back pain:

Consider getting a new mattress.

You likely spend long periods in bed every night, so the best mattress for back pain can go a long way towards helping you feel more comfortable. Experts recommend sleeping on a medium-firm mattress for low back pain, which provides sturdy support. Too-soft mattresses can sink and potentially through your back out of alignment. What’s more, surveys suggest that sleeping on very firm or orthopedic mattresses can actually make sleep quality worse.

As for the best mattress type? Memory foam tends to do a better job of conforming to your body’s natural curves, which could help promote better spinal alignment. That’s not to say innerspring beds are off-limits. It’s entirely possible to sleep well on one that’s firm and well made. But you may want to consider adding a memory foam topper for added support, recommends Cleveland Clinic experts.

While bed in a box mattresses are the more popular options nowadays, we recommend those with back pain shop in-store or shop with a brand offering white glove delivery because mattresses in a box are heavy and relatively difficult to maneuver. If you have back pain, unboxing and unrolling one of these isn’t going to be easy, and could possibly exasperate your current discomfort.

Get into position.

Sleeping on your side is a good way to promote proper alignment, the NIH says. If you want to experiment with being a side sleeper, tuck your legs and keep a firm pillow between your knees. That can ease stress on your lower back and hips and offer significant pain relief. Sleeping on your right side may be preferable to sleeping on your left, since some research suggests right-side sleeping may put less strain on vital organs.

Sleeping on your back is another good option. By evenly distributing your body weight, back sleepers keep too much pressure from building up in one spot. To further reduce stress on your spine, tuck a small pillow under your knees.

It’s best to avoid sleeping on your stomach if possible. Stomach sleepers put lots of pressure on their backs and promote an unnatural spinal alignment, which can cause back pain or make existing pain worse. If it’s your favorite way to sleep, tucking a flat pillow under your lower abdomen and pelvis can promote better alignment—and hopefully help keep back issues at bay.

Use the right pillow.

Pillows are key for keeping your head, neck, and spine properly aligned while you sleep. If you’re sleeping on a firm-ish mattress (which is the best kind for back pain), use a thick pillow. Since your shoulders don’t sink deep into a firm mattress, a thick, sturdy pillow will keep your head elevated at the right angle to prevent upper back strain and neck pain, Cleveland Clinic experts say. Opt for pillows made from memory foam or latex, which provide more structure and support than polyester pillows.

Other Steps for Easing Back Pain

Nighttime back pain might ease up just by changing your sleep position, mattress, or pillows. But if that’s not enough, making the right moves during the day can also help. When you’re trying to baby your back to prevent or reduce sleep-related pain, consider taking other steps like:

Maintaining good posture while you’re standing or sitting. Don’t slouch, and try to sit in chairs that offer good lumbar support.

Warm up and stretch before you exercise.

Wear shoes that are comfortable and supportive. Flats or low heels are best.

Don’t try to lift objects that are too heavy. If it seems like lifting something would cause you to strain, find someone to help.

Keep your weight in check. Excess body fat strains your back.

The Bottom Line

Sleep-related back pain can be hard to deal with, but it’s worth addressing. If at-home measures like changing your sleep surface or sleep position or making lifestyle changes aren’t cutting it, consider seeking medical advice. Together you and your doctor can develop a more comprehensive plan to ease your aching back and sleep better.

This article is for informational purposes and should not replace advice from your doctor or other medical professional.